PROJECT SUMMARY/ABSTRACT Heart failure causes over 80,000 deaths and $30 billion in spending annually, yet therapies that improve survival and reduce morbidity are underutilized. Insufficient healthcare quality and high costs sparked the development of value-based payment programs, such as Medicare?s Merit-based Incentive Program (MIPS). MIPS is the largest clinician value-based payment program in use in the United States. MIPS is intended to improve the quality of care while reducing costs by altering clinician payments based on clinician performance on cost and quality measures. MIPS quality measurement is increasing its focus on patient-reported outcome (PRO) measures, including for heart failure, despite limited evidence that PROs improve heart failure care. Aim 1 will be a pragmatic, single-center randomized trial evaluating whether integration of PRO assessment into the routine heart failure clinic workflow is feasible and improves health-related quality of life at one year. This patient-oriented trial will determine if the clinical impact of PRO assessment is worth the costs of data collection. Aim 2 will evaluate the association between the introduction of MIPS (in 2017) and trends in Medicare heart failure care: guideline-recommended therapy use, mortality, and costs. This study will use multiple analytic approaches and controls (VA and commercially insured heart failure patients) to develop robust estimates of these associations. This work will have a substantial impact on heart failure clinical care and patient outcomes by defining the effect of both routine PRO assessment and MIPS as a whole. It will inform the design of future clinician value-based payment models. Dr. Sandhu will use this research along with the protected time, training, and mentorship of this K23 Award to become an independent, patient-oriented health services researcher. Dr. Sandhu?s long-term research goals are to improve the quality and efficiency of heart failure patient care by evaluating the implementation of local quality improvement and national health policy. The proposed research experience and the training in clinical trials and causal inference statistics during this award is critical to achieving those goals. He will gain these skills through coursework, local research seminars, national conferences, and direct instruction from his mentorship team. His mentors are experts in implementation trials, outcomes analysis, and advanced statistical methods. They are supplemented with an exceptional advisory committee with complementary expertise in clinical trials, heart failure, and health policy. With this mentorship team and support from the Stanford Department of Medicine, Dr. Sandhu will have the tools to efficiently complete the trial in Aim 1. His rigorous training plan, the expertise of his mentors, and his experience with the data make the sophisticated policy analysis in Aim 2 feasible. Overall, the training, research, and mentorship of this award will guide Dr. Sandhu in his transition to becoming an independent, successful patient-oriented health services researcher with the skills to compete for R-level funding.